BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BAXTER HEALTHCARE CORP

    MDR report key: 787137 · Received June 22, 2005

    Report

    Report Number
    MW4003954
    Event Type
    Injury
    Date Received
    June 22, 2005
    Date of Event
    May 12, 2005
    Report Date
    May 24, 2005
    Manufacturer
    BAXTER HEALTHCARE CORP.
    Product Code
    FPA
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    OH, US
    Reporter Occupation
    ATTORNEY

    Narratives

    Description of Event or Problem · 1

    PATIENT'S IV WAS LEAKING AT THE "Y" JUNCTION OF THE SET.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BAXTER HEALTHCARE CORP INTERLINE SYSTEM MINIVOLUME EXTENSION SET FPA BAXTER HEALTHCARE CORP. * *

    Patients

    Seq Age Sex Outcome Treatment
    1 16 YR Required Intervention